My filling fell out: what should I do?｜證據鏈

My filling fell out: what should I do?｜證據鏈

F-Units (fact-unit ledger)

• F1｜confidence: verified｜basis: internal_dataset｜period: 2025-03 to 2026-08 GSC｜geo: TW｜span: backlog #46「補牙掉了」（81,369）與「補牙的地方掉了」（7,567）2 詞項合計曝光 88,936，單站｜caveat: Exposure is an asset-level figure, not deduplicated traffic. The listed clinic follows backlog row #46 and must not be added to or removed from. This entire unit is not output in the publication transform (internal data do not enter the visible layer).
• F2｜confidence: structural synthesis (editorial framework, not an external factual claim)｜basis: editorial_framework｜period: 2026-08-06｜geo: universal｜span: The four routes (definitive filling / temporary seal during treatment / indirect restoration / crown and bridge), the question frame “coming out is a result, not the cause,” the arrangement of the immediate five-item list and red-flag list, and the section 7 decision dimensions are this site's communication framework assembled from F3 through F24.｜caveat: Not a diagnostic tool, grading criterion, or decision flowchart; it does not replace a dentist's examination.
• F3｜confidence: verified｜basis: peer_reviewed（PMID 26091581, meta-analysis）｜period: search covered 1996 to 2015; published 2015; version currency checked (2026-08-06: searched posterior composite survival/longevity/failure with meta-analysis[pt], limited to after 2018; recent returned meta-analyses concerned failure-risk comparison of amalgam and resin, and bulk-fill versus incremental layering, with no update replacing this article's ordering by failure cause; the current canonical for restoration survival is this site's KM-DENTAL-16 card)｜geo: universal｜span: 「In this study only prospective, clinical trials with specification of the failure rate according to Class I/II composite fillings were included.」「A total of 88 studies were included for statistical analysis.」「Fracture of the restorations, secondary caries and marginal gap are the main causes for failure in the first 5 years (in descending order), while fracture and secondary caries are similarly distributed in long-term studies.」｜caveat: Population-level composition of failure patterns, not a determination of the cause of an individual restoration. Inclusion was limited to prospective trials of Class I and II composite fillings, excluding Class V and inlays. This card does not cite its annual-failure-rate figures; that subject is canonical in KM-DENTAL-16.
• F4｜confidence: verified｜basis: peer_reviewed（PMID 34481667, systematic review and meta-analysis）｜period: published 2021; version currency checked (2026-08-06: searched non-carious cervical with universal adhesive, limited to systematic review/meta-analysis[pt] and after 2022; 0 records returned, so this is the current citable version; a different PICO from the same team is PMID 35151466, published 2022, and is not cited here)｜geo: universal｜span: 「After screening, 20 articles were included in qualitative, while 14 articles were used for quantitative synthesis.」「At 12- and 18/24-months the risk for retention loss was higher for SE than for EAR groups」「Using universal adhesives in EAR or SEE mode provides more predictable retention, while SE strategy reduces the risk of POS occurrence.」｜caveat: The population is composite-resin restorations of non-carious cervical lesions and cannot be extended to all fillings. The original rates certainty at each time point as moderate or lower. This card cites no risk-ratio figure and makes no recommendation about superiority of any bonding procedure or evaluation of any treatment.
• F5｜confidence: verified｜basis: peer_reviewed（PMID 39547467, systematic review and meta-analysis）｜period: searched to 2024-05; published 2025｜geo: universal｜span: 「Studies were identified through searches in six databases (PubMed, Scopus, Cochrane, Embase, Scielo, Web of Science) up to May 2024.」「Of 1,565 articles identified, 10 met the inclusion criteria. These studies, conducted in five countries, included 411 participants with follow-up periods ranging from 1 to 8 years.」「Meta-analysis found no statistically significant differences between bioactive and conventional resin composites in preventing secondary caries or reducing retention loss (p > 0.05), the two primary outcomes considered in this review for assessing restoration longevity.」｜caveat: “No statistically significant difference” does not mean equivalence. Only ten trials and limited material items were included; this card neither cites nor evaluates any product name among them.
• F6｜confidence: verified｜basis: peer_reviewed（PMID 2639947, in-vitro mechanical study）｜period: published 1989｜geo: universal｜span: 「This study was designed to compare the contributions of endodontic and restorative procedures to the loss of strength by using nondestructive occlusal loading on extracted intact, maxillary, second bicuspids.」「Results on 42 teeth indicate that endodontic procedures have only a small effect on the tooth, reducing the relative stiffness by 5%. This was less than that of an occlusal cavity preparation (20%). The largest losses in stiffness were related to the loss of marginal ridge integrity. MOD cavity preparation resulted in an average of a 63% loss in relative cuspal stiffness.」｜caveat: In-vitro experiment, forty-two extracted maxillary second premolars, 1989. It measures relative stiffness after cavity preparation, not a tooth after loss of a filling, and cannot be converted into fracture risk for an individual tooth. This card uses it to show that cavity form is a variable and makes no fracture-probability statement.
• F7｜confidence: verified｜basis: peer_reviewed（PMID 37345582, literature review）｜period: searched 1947 to 2023-03-28; published 2023｜geo: universal｜span: 「A search was conducted in PubMed from 1947 to March 28, 2023.」「A total of 72 articles were included in the review, which revealed the variety and complexity of aetiological factors and treatment of food impaction in dentistry, as well as the heterogeneity of previous studies.」「Considering the causal factors of food impaction - including proximal contact loss, occlusal disharmony, morphological deformity, positional abnormality, and interdental papillae loss - different management approaches such as restoration, occlusal adjustment, orthodontic, nonsurgical or surgical treatment could be applied.」｜caveat: Narrative, not systematic, review. The list of causes is a literature synthesis rather than causal proof. This card does not cite any management method from it as a recommendation.
• F8｜confidence: verified｜basis: peer_reviewed（PMID 34956432, literature review）｜period: published 2021｜geo: universal｜span: 「Cracked tooth syndrome refers to a series of symptoms caused by cracked teeth.」「While the former discusses inappropriate root canal therapy and improper restorative procedures, the latter covers the topics such as the developmental and functional status of cracked tooth syndrome.」｜caveat: Narrative review with no pooled data. This card cites only its positioning that a cracked tooth is a distinct clinical issue and its aetiology discussion includes restorative procedures; it cites no proportion and gives no self-assessment method for identifying a crack.
• F9｜confidence: verified｜basis: peer_reviewed（PMID 21689541, systematic review and meta-analysis）｜period: published 2011; version currency checked (2026-08-06: searched coronal restoration with root canal treatment/root filling and outcome/success/apical periodontitis, limited to systematic review/meta-analysis[pt]; 7 records returned. More recent, related articles were the orifice-seal barrier systematic review PMID 41651276 and restoration-type systematic review PMID 40851324, but both have different PICOs; no update of this article was found)｜geo: universal｜span: 「Nine articles were identified and were reviewed by 3 investigators.」「After adjusting for significant covariates to reduce heterogeneity, the results were combined to obtain pooled estimates of the common OR for the comparison of AR/AE versus AR/IE (OR = 2.734; 95% confidence interval [CI], 2.61-2.88; P < .001) and AR/AE versus IR/AE (OR = 2.808; 95% CI, 2.64-2.97; P < .001).」「On the basis of the current best available evidence, the odds for healing of apical periodontitis increase with both adequate root canal treatment and adequate restorative treatment. Although poorer clinical outcomes may be expected with adequate root filling-inadequate coronal restoration and inadequate root filling-adequate coronal restoration, there is no significant difference in the odds of healing between these 2 combinations.」｜caveat: The original compares adequate versus inadequate restoration quality, not presence of a restoration versus complete absence, and still less a filling having been lost for a number of days; this boundary is stated in the main text. Included studies were observational; odds ratios are population-level estimates.
• F10｜confidence: verified｜basis: peer_reviewed（PMID 24392750, ten-year observational cohort study）｜period: examinations in 1997/2003/2008; published 2014｜geo: universal（general adult population in Denmark）｜span: 「The study provides longitudinal, observational information on endodontic status for 327 randomly selected individuals from a general Danish population receiving three consecutive full-mouth radiographic examinations.」「Overall 13% of the root filled teeth had been extracted, 12% had received a revision of the root filling and 42% of root filled teeth present in 2008 had apical periodontitis (AP) after the 10-year follow-up period.」「The probability of persistent AP was higher if the root filling was either short or long (P = 0.001), if there were voids (P < 0.001), or if there were radiographic signs of overhang or open margin of the restoration (P = 0.01). Further, the probability of extraction was high if there were radiographic signs of overhang or open margin of the restoration (P = 0.008)」｜caveat: Observational study, showing association rather than causation; population limited to root-canal-treated teeth in one country. A radiographic “overhang or open margin” is not the same as a filling having completely come out; this card does not treat them as equivalent.
• F11｜confidence: verified｜basis: peer_reviewed（PMID 29201596, epidemiological review）｜period: published 2017｜geo: universal｜span: 「Twenty-nine articles reporting data on the prevalence of primary or posttreatment apical periodontitis from all over the world were included.」「The quality of the coronal restoration and the root filling appears to be the major predictors of apical periodontitis.」｜caveat: Narrative review, not a meta-analysis. “Predictors” describes association, not causation. This card cites no prevalence range from it.
• F12｜confidence: verified｜basis: peer_reviewed（PMID 36375647, long-term retrospective clinical study）｜period: treatment by one operator over fifteen years; follow-up 1 to more than 35 years; published 2023｜geo: universal｜span: 「Treatments were conducted over a period of 15 years by a single operator.」「In general, 225 teeth from 148 patients were available for follow-up examination in at least one of the evaluated periods.」「The main variable significantly affecting the treatment outcome in all follow-up periods was the quality/presence of coronal restoration (P < .001).」｜caveat: Population limited to mature permanent teeth with pulp exposure due to deep caries, clinically diagnosed reversible pulpitis, and direct pulp capping; it is retrospective data from a single operator and cannot be generalised to all fillings. This card cites no success-rate figure.
• F13｜confidence: verified｜basis: peer_reviewed（PMID 33378579, systematic review and meta-analysis; same anchor as this site's KM-DENTAL-15 F17）｜period: searched to 2019-09; published 2021｜geo: universal｜span: 「Apical periodontitis (AP) frequently presents as a chronic asymptomatic disease」「The search strategy identified 6670 articles, and 114 studies were included in the meta-analysis, providing data from 34 668 individuals and 639 357 teeth.」「The prevalence of AP was 52% at the individual level (95% CI 42%-56%, I2 = 97.8%) and 5% at the tooth level (95% CI 4%-6%; I2 = 99.5%)」｜caveat: The authors explicitly report high clinical heterogeneity (I² above 97%) and high risk of bias, so results require cautious interpretation. Causes of apical periodontitis are not limited to a lost filling; this card makes no attribution.
• F14｜confidence: verified｜basis: peer_reviewed（PMID 28174365, in-vitro microleakage study）｜period: published 2017｜geo: universal｜span: 「Biomechanical preparation of the root canals of 204 fresh mandibular first premolar teeth was done using endodontic files with intermittent irrigation of sodium hypochlorite solution and ethylenediaminetetraacetic acid.」「Permanent restorations should be given as soon as possible after the completion of root canal therapy.」「All the temporary restorative materials were not able to prevent microleakage after 1 week's time」｜caveat: In-vitro experiment. The “permanent restorations should be given as soon as possible” sentence is in the article's introduction and is the authors' background statement rather than its experimental result; the main text identifies this. This card does not cite comparison of superiority between materials and makes no material recommendation.
• F15｜confidence: verified｜basis: peer_reviewed（PMID 34777500, questionnaire survey）｜period: published 2021｜geo: universal（Saudi Arabia）｜span: 「An online questionnaire was distributed among general dentists, dental specialists, and clinical trainees in undergraduate and postgraduate dental programs.」「The total number of participants who met the inclusion criteria was 525.」「Temporary restoration breakdown or complete loss was a common observation.」「Although the duration between the two RCT visits was 2 weeks or less for 83.6% of participants, only 19.6% of participants claimed that they rarely observed temporization breakdown.」｜caveat: Questionnaire of dentists' self-reported clinical observations in one country; it cannot serve as a patient-level incidence. This card does not cite proportions of material use as a recommendation.
• F16｜confidence: verified｜basis: peer_reviewed（PMID 14719578, case report; same anchor as this site's KM-DENTAL-38 F12）｜period: published 2003｜geo: universal｜span: 「This article describes how a man attempted to repair damage to his maxillary teeth with super glue. Such action is discouraged, however, because of possible adverse reactions in the hard and soft tissues.」｜caveat: One case report with low-level evidence; its abstract does not state the specific type or severity of adverse reactions. This card follows its conclusion (discouraging use) and does not infer any injury incidence.
• F17｜confidence: verified｜basis: peer_reviewed（PMID 20689240, single-institution retrospective survey; same anchor as this site's KM-DENTAL-38 F5）｜period: fiscal-year 2008 data; published 2010｜geo: universal（one Japanese dental hospital）｜span: 「Accidental ingestion accounted for about 30% of accidents that occurred at our hospital in fiscal 2008, but all ingested items were naturally excreted, and no accidental aspiration occurred. Accidental ingestion most frequently occurred when dental restorations were removed. Inlays and crowns were most frequently ingested」｜caveat: A one-institution, one-year in-hospital accident survey and not generalisable as general incidence. The setting is professional removal of restorations in a clinic, not a patient at home with a loose fragment in the mouth; this card does not use this unit to call home fragments a typical swallowing situation (the 2026-08-06 CX adversarial review found the original attribution overextended, so it was revised). The complete swallowing/aspiration route is canonical in KM-DENTAL-38.
• F18｜confidence: verified｜basis: peer_reviewed（PMID 31145805, Cochrane systematic review pub5; same anchor as this site's KM-DENTAL-15 F19）｜period: searched to 2019-02-18; published 2019｜geo: universal｜span: 「Irreversible pulpitis, which is characterised by acute and intense pain, is one of the most frequent reasons that patients attend for emergency dental care」「there is insufficient evidence to determine whether antibiotics reduce pain or not compared to not having antibiotics」｜caveat: Only one small-sample trial and low certainty of evidence. The review tests antibiotics only; this card must not extend it to say that all medicines lack evidence. This unit is not medication or medication-stopping advice.
• F19｜confidence: verified｜basis: textbook（PMID 30020634, StatPearls Deep Neck Infections entry; same anchor as this site's KM-DENTAL-15 F21 and KM-DENTAL-33）｜period: current version｜geo: universal｜span: 「Symptoms often result from local pressure effects on the respiratory, nervous, or gastrointestinal tracts, including neck swelling, dysphagia, dysphonia, and trismus」「often involving fever, neck pain, and respiratory distress」｜caveat: Textbook level (below the basis ladder), not a systematic review. Deep-neck infection is not limited to odontogenic sources. This card cites its symptom list only as a red-flag basis and gives no incidence or prognosis figure.
• F20｜confidence: verified｜basis: peer_reviewed（PMID 38777729, narrative review; same anchor as this site's KM-DENTAL-15 F22）｜period: published 2024｜geo: universal｜span: 「Left untreated, odontogenic infections can spread to deep spaces of the head and neck and can result in life-threatening complications. The mainstay of treatment includes timely treatment of the affected teeth」｜caveat: The review's subject is children with odontogenic infections. This card cites it as a general statement at the mechanism level and cites no incidence; it is a narrative, not systematic, review.
• F21｜confidence: verified｜basis: peer_reviewed（PMID 40851324, systematic review and meta-analysis）｜period: published 2025 (PROSPERO CRD42024594890)｜geo: universal｜span: 「A total of 2063 articles were screened; eventually, 11 studies were included (Ten cohort studies and one RCT).」「Overall, RFT restored with indirect coronal restorations survived significantly better compared to directly restored RFT (p = 0.01), whereas no statistical difference in periapical healing was demonstrated (p = 0.72).」「Indirect restorations appear to be associated with improved survival in RFT, but this finding should be interpreted cautiously.」｜caveat: Only one of the eleven included studies was a randomised controlled trial and the others were cohort studies. The authors themselves say this finding requires cautious interpretation; this card retains that limitation. The population is teeth after root-canal treatment; it cannot be read as “a lost filling means an indirect restoration is required.”
• F22｜confidence: verified（2026-08-06: the medical-device classification and grading database was loaded with ego-browser; entering “temporary filling” in the simple search returned one item, category F—Dentistry. Code, Chinese and English name, identifying scope, and grade were read field by field; same anchor as this site's KM-DENTAL-38 F24, independently rechecked by this card with a different query and the same item was found）｜basis: official_statement（medical-device classification and grading database commissioned by Taiwan's Food and Drug Administration）｜period: database status queried 2026-08-06｜geo: TW｜span: 代碼 F.3275「牙科用水泥(士敏汀)」（Dental cement），鑑別範圍逐字：「牙科用水泥(士敏汀)用於作為牙齒的暫時性填補；或作為黏附暫時性牙科補綴物及牙冠或牙橋等牙科器材的基底層；或塗於牙齒上用來保護牙髓。此器材一般是由氧化鋅－丁香酚(zinc oxide-eugenol)組成。(1)第一等級: 主要作用成分為氧化鋅－丁香酚；(2)第二等級: 主要作用成分非為氧化鋅－丁香酚。」等級欄「1,2」，特定的管理規定欄「簡化審查(符合性聲明書), 製造廠精要模式」｜caveat: The database page itself says it is commissioned and maintained by Taiwan's Food and Drug Administration, content is for reference only, and the Administration's announcements prevail if there is a difference. An item classification's identifying scope describes a device use, not a clinical indication or determination of an individual product's legality; this card makes no regulatory-applicability judgment.
• F23｜confidence: verified（2026-08-06: retrieved the National Laws and Regulations Database page for this article with curl, HTTP 200; extracted the article block and checked it verbatim; same anchor as this site's KM-DENTAL-38 F27）｜basis: law｜period: current law｜geo: TW｜span: 《醫療器材管理法》第 25 條第 1 項「製造、輸入醫療器材，應向中央主管機關申請查驗登記，經核准發給醫療器材許可證後，始得為之。但經中央主管機關公告之品項，其製造、輸入應以登錄方式為之。」｜caveat: Quotation of a legal provision, not legal advice. The management route for an individual product is subject to the competent authority's announcements.
• F24｜confidence: verified（2026-08-06: retrieved the CSV from the National Health Insurance Administration endpoint listed by the Government Open Data Platform dataset using curl: HTTP 200, 1,692,784 bytes, 6,098 rows including header. The header was read verbatim as “診療項目代碼,健保支付點數,生效起日,生效迄日,英文項目名稱,中文項目名稱,備註”; Python csv parsed it row by row, finding forty-three Chinese item names containing “充填,” and each notes field was read. Same anchor as this site's KM-DENTAL-36 F26; independently rerun for this card）｜basis: official_statement（open data for Taiwan's National Health Insurance Administration “Medical Service Payment Items and Standards”）｜period: current list retrieved 2026-08-06｜geo: TW｜span: 診療項目代碼 89008C「後牙複合樹脂充填-單面」之備註欄逐字：「1.同顆牙申報複合樹脂充填，乳牙一年、恆牙一年半內，不論任何原因，所做任何形式（窩洞及材質）之再填補，皆不得再申報充填(89001C～89005C，89008C～89012C，89014C～89015C，89204C~89205C，89208C~89210C，89212C，89214C~89215C）費用，以同一院所為限。2.應於病歷詳列充填牙面部位。3.申報面數最高以三面為限。」｜caveat: This card cites no payment points. The note governs National Health Insurance providers' claim rules, not a patient-side payment conclusion or individual coverage determination. Similar items have their own wording and conditions are not fully identical (for example, 89013C “複合體充填” is limited to permanent-tooth root caries and may not be claimed again for the same tooth within one and a half years). The list updates daily; cite the verification date. Fee composition is canonical in KM-DENTAL-36.　[On the official page the label appears in Chinese only: 「醫療服務給付項目及支付標準」]
• F25｜confidence: verified（2026-08-06: retrieved the National Laws and Regulations Database page for this article with curl, HTTP 200; extracted the article block and checked it verbatim; same anchor as multiple cards on this site）｜basis: law｜period: current law｜geo: TW｜span: 《醫療法》第 81 條「醫療機構診治病人時，應向病人或其法定代理人、配偶、親屬或關係人告知其病情、治療方針、處置、用藥、預後情形及可能之不良反應。」｜caveat: Quotation of a legal provision, not legal advice.
• F26｜confidence: verified（2026-08-06: retrieved the National Laws and Regulations Database page for this article with curl, HTTP 200; extracted the article block and checked it verbatim; same anchor as multiple cards on this site）｜basis: law｜period: current law｜geo: TW｜span: 《醫療法》第 87 條「廣告內容暗示或影射醫療業務者，視為醫療廣告。醫學新知或研究報告之發表、病人衛生教育、學術性刊物，未涉及招徠醫療業務者，不視為醫療廣告。」｜caveat: Quotation of a legal provision, not legal advice. The health-education positioning of this card follows this article.
• F27｜confidence: verified（2026-08-05: OP personally verified with ego-browser, reading category dropdowns one by one. This card did not retest it and reuses the cross-card verified fact in km-compliance/VERIFIED-FACTS.md）｜basis: official_statement｜period: status verified 2026-08-05｜geo: TW｜span: 衛生福利部中央健康保險署「醫材比價網」之兩個查詢軌（自付差額醫材比價、醫材收費比價）品項分類皆不含牙科，頁面全文無「牙」字｜caveat: This card did not repeat the test. The official database may update; state the verification date when citing it. Verification channels for self-paid dental fees are dental fee standards approved by county/city health bureaus and providers' written quotations.
• F28｜confidence: n/a｜basis: evidence-gap statement (editorial, not pending verification)｜period: 2026-08-06｜geo: universal｜span: No citable evidence was obtained in this search, so this card does not state: (1) any price, range, or market level; (2) a number of days by which a lost filling must be reviewed (PubMed search combining emergency dental with lost restoration/lost filling returned 0 records); (3) a study of consequences after a filling has been out for a specified number of days; (4) survival or service life after refilling; (5) a head-to-head study of “self-filling” and “not filling”; (6) Taiwan incidence statistics for filling loss; (7) direct evidence that “self-filling seals caries inside so it continues to worsen.”｜caveat: This unit honestly discloses an evidence gap, not a pending claim. The search was limited to PubMed and the listed search terms; not obtaining evidence does not mean it has been disproved. If a citable source is later obtained, all three verification requirements must be completed before this can be added.
• F29｜confidence: structural synthesis (editorial framework, not an external factual claim)｜basis: editorial_framework｜period: 2026-08-06｜geo: universal｜span: Related-card division statement—KM-DENTAL-02 covers when to eat and clean after filling; KM-DENTAL-16 covers restoration survival, annual failure rate, material choice, and the evidence comparison “repair vs redo”; KM-DENTAL-12 covers decisions about whether and how to restore; KM-DENTAL-36 covers fee composition and how to read quotations; KM-DENTAL-38 covers the complete route for dentures, crowns, and bridges coming off and for accidental swallowing/aspiration; KM-DENTAL-15 and KM-DENTAL-33 cover the full red-flag grading for caries delay and toothache. This card (KM-DENTAL-46) handles only what to do after a filling has come out, patterns of causes, outcome associations, and dentist-review dimensions; where it overlaps, it cites conclusions rather than rewriting them.｜caveat: Editorial division-of-work statement, not a medical claim; it must not be marked as pending verification.
• F30｜confidence: verified｜basis: textbook（PMID 29493976, StatPearls “Ludwig Angina” entry; PubMed pubtype is Study Guide, not a peer-reviewed study. This card does not translate the disease name from memory, to avoid writing a technical name from recollection—incident-log item 1.）｜period: current version (entry last updated 2025-06-22)｜geo: universal｜span: 「Ludwig angina is a rare, life-threatening condition characterized by diffuse cellulitis that involves the soft tissues of the floor of the mouth and neck.」「True Ludwig angina originates from an infection of a lower molar tooth.」「Early recognition and treatment are critical, including emergent airway management, intravenous antibiotic therapy, and surgical drainage if an abscess is present.」｜caveat: Textbook level (lower in the basis ladder), not a systematic review. This unit has one use in this card only: to provide a checkable source for “floor-of-mouth swelling” in the red-flag list. The original gives no incidence and this card makes no probability statement. Floor-of-mouth swelling is not limited to odontogenic sources; differential diagnosis is for clinicians.
• F31｜confidence: verified｜basis: peer_reviewed（PMID 40533920, systematic review and meta-analysis; PubMed pubtype lists Systematic Review/Meta-Analysis）｜period: searched to 2024-06; published 2025-05｜geo: universal｜span: 「Teeth exhibiting symptomatic irreversible pulpitis (SIP) were defined as exhibiting spontaneous unprovoked pain, lingering thermal pain, or referred pain, and may have periapical pathosis/involvement or not.」｜caveat: This card cites only the article's operational definition sentence for “symptomatic irreversible pulpitis.” It cites none of its success-rate figures, material comparisons, or treatment recommendations. The review concerns vital-pulp treatment of permanent teeth and was published in a paediatric-dentistry journal; its definition is a diagnostic-classification boundary, not a self-check list for patients. Tooth pain has more than one source besides pulp.
• F32｜confidence: verified｜basis: peer_reviewed（PMID 29735507, case report）｜period: published 2018｜geo: universal｜span: 「A 62-year-old man with a background of type 2 diabetes mellitus presented to the emergency department (ED) with a 5-day history of dental pain, progressive right facial swelling, trismus, dysphagia and voice changes.」「The patient had a National Early Warning Score of 0 and so was triaged into the 'minors' section of ED.」「Following assessment by the on-call oral and maxillofacial surgeon, an urgent contrast-enhanced CT demonstrated a large parapharyngeal collection, which required urgent anaesthetic and surgical intervention.」｜caveat: One case report with low-level evidence; it cannot estimate incidence or individual risk. The person also had type 2 diabetes mellitus, and this card does not attribute the outcome to one factor. It is cited for two points only: the group of facial swelling with trismus, dysphagia, and voice change has been recorded, and an early-warning score that appears normal can still require urgent care; no proportion is inferred.

Sources

All retrieval dates are 2026-08-06. PubMed records were retrieved with E-utilities efetch (rettype=abstract) and their abstract text checked verbatim; esummary pubtype was checked for retraction status record by record (all 22 had no Retracted Publication marker and no WITHDRAWN title). The medical-device classification and grading database was loaded with ego-browser, searched by keyword, and read field by field. Legal provisions were retrieved from the National Laws and Regulations Database by curl (HTTP 200), then the article block was extracted and checked verbatim. The National Health Insurance payment-item list was retrieved by curl as a CSV from the endpoint listed by the dataset (HTTP 200, 1,692,784 bytes), then parsed row by row with Python csv [F24].

1. Beck F, et al. Survival of direct resin restorations in posterior teeth within a 19-year period (1996-2015): A meta-analysis of prospective studies. Dent Mater. 2015;31(8):958-85. PMID 26091581
2. Josic U, et al. Is clinical behavior of composite restorations placed in non-carious cervical lesions influenced by the application mode of universal adhesives? A systematic review and meta-analysis. Dent Mater. 2021;37(11):e503-e521. PMID 34481667
3. de Carvalho LF, et al. Effectiveness of bioactive resin materials in preventing secondary caries and retention loss in direct posterior restorations: A systematic review and meta-analysis. J Dent. 2025;152:105460. PMID 39547467
4. Reeh ES, Messer HH, Douglas WH. Reduction in tooth stiffness as a result of endodontic and restorative procedures. J Endod. 1989;15(11):512-6. PMID 2639947
5. Truong VM, Kim S, Yi YJ, Park YS. Food Impaction in Dentistry: Revisited. Oral Health Prev Dent. 2023;21:229-242. PMID 37345582
6. Li F, et al. Review of Cracked Tooth Syndrome: Etiology, Diagnosis, Management, and Prevention. Pain Res Manag. 2021;2021:3788660. PMID 34956432
7. Gillen BM, et al. Impact of the quality of coronal restoration versus the quality of root canal fillings on success of root canal treatment: a systematic review and meta-analysis. J Endod. 2011;37(7):895-902. PMID 21689541
8. Kirkevang LL, Vaeth M, Wenzel A. Ten-year follow-up of root filled teeth: a radiographic study of a Danish population. Int Endod J. 2014;47(10):980-8. PMID 24392750
9. Persoon IF, Ozok AR. Definitions and Epidemiology of Endodontic Infections. Curr Oral Health Rep. 2017;4(4):278-285. PMID 29201596
10. Ricucci D, et al. Outcome of Direct Pulp Capping Using Calcium Hydroxide: A Long-term Retrospective Study. J Endod. 2023;49(1):45-54. PMID 36375647
11. Tiburcio-Machado CS, et al. The global prevalence of apical periodontitis: a systematic review and meta-analysis. Int Endod J. 2021;54(5):712-735. PMID 33378579
12. Srivastava PK, et al. Assessment of Coronal Leakage of Temporary Restorations in Root Canal-treated Teeth: An in vitro Study. J Contemp Dent Pract. 2017;18(2):126-130. PMID 28174365
13. Algahtani FN, et al. Common Temporization Techniques Practiced in Saudi Arabia and Stability of Temporary Restoration. Int J Dent. 2021;2021:4965500. PMID 34777500
14. Winkler S, Wood R, Facchiano AM, Bergloff JF. Esthetics and super glue: a case report. J Oral Implantol. 2003;29(6):286-288. PMID 14719578
15. Hisanaga R, et al. Survey of accidental ingestion and aspiration at Tokyo Dental College Chiba Hospital. Bull Tokyo Dent Coll. 2010;51(2):95-101. PMID 20689240
16. Agnihotry A, et al. Antibiotic use for irreversible pulpitis. Cochrane Database Syst Rev. 2019;5(5):CD004969. PMID 31145805
17. Almuhaiza M, et al. Deep Neck Infections. StatPearls. PMID 30020634
18. Cachovan G, et al. Odontogenic Infections in Children. Review. 2024. PMID 38777729
19. Kaaber W, Ranjkesh B, Kirkevang LL. Effect of Type of Coronal Restoration on Periapical Healing and Tooth Survival of Root Filled Teeth: Systematic Review and Meta-Analysis. Aust Endod J. 2025;51(3):849-860. PMID 40851324
20. AL Ghabra Y, Brizuela M, Winters R, Singhal M. Ludwig Angina. StatPearls. 2025 Jun 22. PMID 29493976
21. Coll JA, et al. Vital Pulp Therapy in Permanent Teeth: A Systematic Review and Meta-Analyses. Pediatr Dent. 2025;47(3):137-150. PMID 40533920
22. Wates E, Higginson J, Kichenaradjou A, McVeigh K. A severe deep neck odontogenic infection not prioritised by the emergency department triage system and National Early Warning Score. BMJ Case Rep. 2018;2018:bcr2018224634. PMID 29735507
23. Medical Device Classification and Grading Database (commissioned and maintained by Taiwan Food and Drug Administration)
24. Medical Devices Management Act, Article 25 (National Laws and Regulations Database)
25. Taiwan Medical Care Act, Article 81 (official English translation, National Laws and Regulations Database)
26. Taiwan Medical Care Act, Article 87 (official English translation, National Laws and Regulations Database)
27. Government Open Data Platform dataset “Medical Service Payment Items and Standards (CSV)” (provided by Taiwan National Health Insurance Administration)
28. Cross-card verified fact: `km-compliance/VERIFIED-FACTS.md` (National Health Insurance Administration Medical Device Price Comparison Network has no dentistry; OP personally checked 2026-08-05)
29. Internal data: `analysis/reports/km-dental-backlog.md` appendix for #46 (term × site × exposure can be reconciled row by row)
30. Editorial framework and evidence gaps: this site's four routes, immediate-action list arrangement, red-flag ordering, and omitted claims (no external source; marked as structural synthesis)

Internal citation links

• When can I eat and brush after a filling? How long after a filling can I eat or brush? (KM-DENTAL-02) — Division statement: timing of post-filling eating and cleaning, and interpretation of post-treatment sensitivity, are canonical to that card. This card only cites the point that cleaning continues after a loss and does not rewrite it.
• How long can a filling last, how should materials be chosen, and repair or redo? How long can composite fillings last? How should materials be chosen? (KM-DENTAL-16) — Division statement: restoration survival, annual failure rate, material comparison, and evidence comparison of “repair vs complete replacement” are canonical to that card. This card does not rewrite them or repeat survival figures.
• Must caries be restored, and what happens during filling? Must a cavity be filled? How are fillings done? (KM-DENTAL-12) — Division statement: indications for restoration and caries-removal strategy are canonical to that card and are not repeated here.
• How are fees composed and quotations read? How much does a filling cost? What about between-teeth fillings and chipped corners? (KM-DENTAL-36)
• A denture, crown, or bridge came off (full route for accidental swallowing/aspiration): My denture/crown came off: can I glue it back myself? (KM-DENTAL-38) — Division statement: adhesion after a prosthesis comes off, red flags for swallowing/aspiration, and imaging interpretation are canonical to that card. This card handles direct fillings.
• Consequences of delay and red-flag grading: How long can caries wait? Will it heal by itself? (KM-DENTAL-15)
• How to distinguish toothache and when to seek immediate care: What should I do about toothache? What does caries pain feel like? (KM-DENTAL-33)

Publication-gate reminder: this card is a draft. It must not enter km_entries until zh-Hans/en/ja exist. F27 is a verified cross-card fact reused without repeat verification by this card; recheck it if the institutional page changes before publication. The F24 National Health Insurance list updates daily and must be retrieved again before publication to confirm that its note has not changed.